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One Company With an Eye on U.S. Customers

Many of the Americans who travel overseas for health care go to India or Thailand, often for bariatric surgery or cosmetic procedures such as breast augmentation. "New Zealand is perceived as a safe option," Watson says. "We're not as cheap as India; we're never going to be as cheap as India." However, New Zealand is cheaper than Singapore, Belgium and Germany, he says. What's more, he says, "for an American coming here, it's not a foreign experience. Yeah, it's different, but you still have Starbucks, you have McDonald's."

Medtral and the Ascot and Mercy hospitals, which are shareholders in the business, go out of their way to show that an American patient's experience in New Zealand will be more grande latte than Big Mac. In preparation for a reporter's visit, an operating room was set up as if for a stent procedure. The manager of Ascot's angiography suite, Ian Summerscale, in scrubs, explained the procedure with input from cardiologist Andrew Maslowski, attired in a blazer and slacks. A half-day tour of both hospitals was arranged and all their beauties pointed out, including artsy flower displays in waiting areas and some of the country's most advanced operating equipment, including robotics.

Luxurious and exotic it may be, but the bottom line for most non-urgent surgery patients is not, well, the bottom line but the safety and effectiveness of the procedure. One patient qualified to compare similar surgeries in the United States and New Zealand is Judy Wingfield, 66, who lives in Auckland and whose experience Medtral advertises on its Web site. She has had both hips replaced with titanium prosthetics, enabling her to go for a walk every day and take Pilates classes. Both experiences were good, she recalls, with similar recovery times.

Wingfield's left hip was replaced in 2003 in New York, where she was living at the time; the other was replaced two years later at the Ascot Hospital. While her American health insurance paid for both procedures, the bill she saw was considerably smaller for the second: $15,000 compared with $75,000. (Milstein comes up with a figure of about $32,000 for hip replacement in the United States for a PPO-style plan.)

The pre-surgical care in New York was more thorough, Wingfield recalls. She was given a "comprehensive" book about her hip replacement and talked it through with her surgeon, but she found her inpatient care in New Zealand better. In New York she was offered a private nurse during her hospital stay for an additional fee. She declined but then "found it difficult to get someone to come and take me to the bathroom. If I needed painkillers, I found it very difficult to get someone to come and help."

It is stories like this and worries about what will and what won't be covered by his insurance that caused 54-year-old Marc Shaw to look into flying to New Zealand for knee replacement surgery. He says his Blue Cross Blue Shield coverage limits the number of post-op physical therapist visits he can make, a particular worry since it took him 14 months to recover from his last knee operation.

He is still weighing his options: "If my insurance company will cover the major share of the cost of the procedure, then I'm inclined to have it done here in California, since my biggest concern is what if something goes wrong," says Shaw, an eighth-grade teacher from Mountain View, Calif. "I really don't want to have to travel back to New Zealand for the sole purpose of doctor visits. That's a bit expensive on a teacher's salary." If his insurer balks at the U.S. expenses, he is ready to make the case for traveling to New Zealand.

Like Horn, Shaw came across Medtral while searching online for knee prosthetics.

The kind of timely response that Horn and Shaw describe is something many New Zealanders themselves have trouble accessing. The country has one of the world's oldest and most comprehensive public health systems, and few New Zealanders have private health insurance. They rely on a sometimes swamped public health system to deal with their complaints, and there are waiting lists for many procedures, including hip replacements and radiotherapy.

Watson says one of the downstream benefits of the Medtral scheme will be improved local care: New Zealand surgeons who have trained and often stayed overseas may be lured back home to work in facilities boasting updated equipment, he says. Other private hospitals, he says, are interested in joining the venture and will be brought on as demand increases.

But the real measure of Medtral's success will be the strides early patients such as Eugene Horn will -- or will not -- make after their medical adventure in New Zealand.

Eleanor Black Watkin is a freelance writer based in Auckland, New Zealand. Comments:health@washpost.com.


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